traumatic injuries: traumatic brain injury knr 279

Traumatic Injuries:Traumatic Brain Injury

KNR 279

TRAUMATIC BRAIN INJURY

Insult to brain, not of degenerative or congenital nature, but caused by an external force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive or physical functioning

Open or closed injury Mild (concussion) to severe (coma)

INCIDENCES OF TBI

Over 2-5 million in US 1 injury every 15 seconds Many result in life long disability 56,000 killed annually Leading cause of death among

Americans under 45 Males 14-24 have highest rate

CAUSES OF TBI

50% Motor vehicle crashes 21% Falls 12% Violence 10% Sports & recreation 7% Other

Symptoms: Frontal Lobe/Foreheadwww.braininjury.com

Paralysis Problems sequencing for multi-step task Persistence of a single thought Inability to focus on task Mood changes/emotional liability Changes in personality Difficulty with problem solving Inability to express language

Parietal Lobe/ Near back & top of head

Inability to attend to more than 1 object at a time

Inability to name an object Inability to locate words for writing Problems reading Difficulty with drawing tasks Difficulty to distinguish left from right Difficulty with math Difficulty with eye-hand coordination

Occipital Lobes: Back of head

Defects in vision (visual field cuts) Difficulty locating objects in the

environment Problems identifying colors Difficulties with reading & writing Visual illusions (inaccurately seeing

objects)

Temporal Lobes: Side of head above ears

Difficulty recognizing faces Difficulty in understanding spoken words Short term memory loss Interference with long term memory Inability to categorize objects Right lobe can cause persistent talking Increased aggressive behavior

Brain stem: Deep within brain

Difficulty swallowing food & water Problems with balance & movement Dizziness & nausea Sleeping difficulties Decreased vital capacity in

breathing needed for speech

Cerebellum: Base of skull

Loss of ability to coordinate fine movements

Loss of ability to walk Tremors Slurred speech Inability to make rapid movements

EFFECTS OF TBI

Balance or equilibrium Behavior / emotion Cognitive Physical Seizures Speech / language

Glasgow Coma Scale

Ranchos Los Amigos ScaleLevel of Cognitive Functioning / Recovery

I = No response, comatose II = Generalized response,

nonpurposeful, inconsistent III = Localized response,

inconsistent reaction to specific stimuli

IV = Confused, agitated, nonpurposeful behavior, inability to process information


V = Confused, inappropriate, nonagitated behavior, alert, highly distractible, responds to simple commands

VI = Confused but appropriate behavior, goal-directed, uses external input for direction


VII = Automatic, appropriate behavior, robot like compliance with routine, shallow recall, increased awareness of others

VIII = Purposeful, appropriate behavior, alert, oriented, independent functioning

Recommended TR Interventions

I, II, III = Sensory stimulation, passive stretching, art, movement to music, cognitive retraining, reality orientation

IV, V, VI = Aquatic therapy, expressive arts, leisure education, horticulture, behavior management, stretching & flexibility exercises, table & board games

Carter, Van Andel, & Robb, 2003

Recommended TR Interventions

VII, VIII = Computer games, Community integration, expressive arts, social skills training

Carter, Van Andel, & Robb, 2003

Considerations/Accommodations

Decrease distractions in environment Provide repetition & consistency Demonstrate new tasks & provide

examples Help with planning Behavior management Guidance with appropriate behavior in

social situations May not remember that just asked

question

Considerations/Accommodations

Structure Start with simple tasks & small

steps Give clear, concrete directions Supervise, may not know own

limitations

traumatic injuries: traumatic brain injury knr 279

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